Motivating Factors for Healthy Lifestyles: An OptumHealth Research Study

Transcription

1 Motivating Factors for Healthy Lifestyles: An Research Study Page 1

2 Motivating Factors for Healthy Lifestyles: An Research Study Study Background and Objectives Unhealthy lifestyles particularly tobacco use and the set of behaviors that contribute to being overweight or obese are a critical issue throughout the United States. Not only do they directly imperil the physical and economic well-being of consumers, they undermine the welfare and stability of employers and insurers who share the direct medical costs and indirect productivity losses of high-risk behaviors. Obesity and Smoking Are Pervasive Health and Cost Risks Fully two-thirds of the U.S. population is currently overweight 1, and nearly every U.S. adult could be overweight within 40 years 2 if current trends continue. Excess weight increases an individual s risk of developing a wide range of diseases, including heart disease, Type 2 diabetes, hypertension, high blood pressure and sleep apnea 3. It also drives significant increases in medical costs. Overweight and obese workers have medical claims that are seven times higher than their fit co-workers 4. Health care costs related to excess pounds are estimated to double each decade, and are projected to reach $957 billion by Cigarette smoking and secondhand smoke cost $96.8 billion in productivity losses annually, according to the CDC. Combined with direct health care expenditures, the total economic burden of smoking is approximately $193 billion per year 6. Smokers miss an average of 6.16 days of work each year due to sickness, compared with 3.86 days for non-smokers 6. Employees who smoke have a significantly higher rate of hospital admissions (124 per 1000 versus 76 for non-smokers), a longer average length of stay (6.47 versus 5.03 days), and make six more visits to health care facilities per year than non-smoking employees 7. Approximately 21 percent of the U.S. adult population currently uses tobacco products, but 70 percent of those want to quit 8. Wellness coaching programs sponsored by health plans and employers seek to help individuals make beneficial changes in their lifestyle choices and health behaviors. Some individuals succeed, but too many do not. If program designers can understand the characteristics, attitudes and motivations that determine individual success, it may be possible to significantly improve program outcomes generally. Research Objectives commissioned GfK Roper Public Affairs and Corporate Communications to conduct research that would help us understand: The priority Americans place on a healthy lifestyle Triggers that lead to successful behavior change for weight loss and smoking Consumer secrets for successful behavior change The perceived benefits of behavior change and the advantages of specific consumer strategies The implications of successful consumer attitudes and strategies for employersponsored wellness programs 2

3 Motivating Factors for Healthy Lifestyles: An Research Study Study Methodology The survey was conducted online from March 24 to April 7, Completed surveys were obtained from 1,444 adults living in the U.S. The survey population included a base sample of 1,003 respondents from the general population of online Americans, as well as oversamples of: 302 people who weighed 200 pounds or more before losing weight, lost at least 20 pounds, and kept the weight off for at least one year. And 330 people who smoked 10 cigarettes or more daily before quitting, and who have been smoke-free for at least one year. The sampling frame was an online panel provided by GfK Roper Public Affairs and Corporate Communications. A survey of 20 minutes in length was conducted. Key Findings Living a Healthy Lifestyle Is a High Priority for Most Americans Seven out of ten respondents say that living a healthy lifestyle is important to them. They give Americans in general only a C or D grade for the healthfulness of their current lifestyles, but most grade themselves a bit higher. The same fraction of respondents (70 percent) believes that their health is mainly determined by their lifestyle choices, not just heredity. Most people rate their own health quite favorably, and are motivated to change their behavior from fear of future health problems. Clearly, the understanding that health is related to behavior, that different behaviors lead to different health outcomes and that behavior is subject to choice has penetrated the public consciousness. Members of the smoking and weight loss groups seem to share an awareness that the behavior change they desire requires a conscious decision. Making a commitment to change was an important success factor cited by both groups. For smokers, the secrets to successful quitting included: Persistence. Most tried several times before succeeding. Key motivations include improving their health (69 percent), feeling better (65 percent), and living longer (62 percent). Close to half say they just wanted to prove they could do it. Finally making the commitment to quit (57 percent). In the weight loss group, 50 percent agree that the key factor in their success was their resolve to reduce weight. Interestingly, the second ranking factor was the experience of seeing themselves in a photograph or mirror (38 percent). The third ranking motivator cited was the inconvenience of being overweight (33 percent). Participants used a variety of methods to reduce weight, with strategies falling into three primary categories: Food-related adjustments (87 percent), ranging from eating less in general to reducing or eliminating certain food types Weight loss plans (71 percent), including employer-provided and self-selected plans, were powerful aids for many people Exercise played a key role in most successful weight loss attempts (69 percent), whether that meant independent exercise or joining a gym 3

4 Motivating Factors for Healthy Lifestyles: An Research Study Most Americans Rate Their Own Lifestyles More Healthy than Others When asked to grade the healthfulness of other Americans lifestyles, most respondents award only a C or worse. Yet a majority gives themselves a grade of B or better. It seems we know there are issues with the typical American lifestyle, even if we re not prepared to frankly evaluate our own. Interestingly, the smoking oversample group is less favorably impressed with other Americans lifestyles than either the general population or the weight loss group; 42 percent of responding smokers give Americans a D for lifestyle healthfulness, compared with 38 percent for the weight loss sample and 33 percent for the general population. The smoking group is also harder when grading the healthfulness of their own lifestyles. 11 percent give themselves a D versus 6 percent of the weight loss sample and 8 percent of the general population. A majority of respondents say that living a healthy lifestyle is a high priority at this point in their lives. On a scale of 1 to 5, where 5 is the highest priority and 1 the lowest, almost one quarter of respondents (22 percent) give health a priority of 5, and nearly half (48 percent) a priority of 4. On average, respondents rate health a priority of 3.9 on a 5-point scale. Those who have quit smoking or lost weight are the most likely to say that health is a high priority 28 percent for each group compared to 22 percent for the general population. More than eight in ten Americans rate their current health as good (67 percent) or excellent (16 percent). Age is a factor, with those under 34 more likely than older respondents to believe themselves in excellent health. Education and income are also factors. College graduates are twice as likely to think themselves in excellent health as high school graduates (20 percent and 10 percent respectively). Those with household incomes over $50,000 are much more likely to claim excellent health than those with incomes under that figure (23 percent versus 9 percent). Significantly, 7 in 10 respondents believe that health is mostly an outcome of lifestyle choices, not genetic destiny. These consumers understand that health is within their control, and they are actively reaching out to different programs, techniques and exercise regimes to successfully meet their behavior change goals. This attitude seems to occur at about the same frequency across the general population, weight loss and smoking cessation groups, and appears to be an indication that employees are accepting greater responsibility for their own health a very positive indicator for wellness program success. 4

5 Motivating Factors for Healthy Lifestyles: An Research Study When asked about their levels of satisfaction with a series of health-related metrics, respondents expressed much greater satisfaction with their mental well-being than with their physical fitness (see figure 1). More than eight in ten (84 percent) are very or somewhat satisfied with their mental well-being, compared with only 60 percent who are equally satisfied with their physical fitness. Even fewer (55 percent) are happy with their body weight. Despite a relatively high level of satisfaction with perceived overall health, an undercurrent of concern is evident. Figure 1: Low Satisfaction with Weight and Fitness Your smoking habits 70% 12% Your blood pressure Your cholesterol level 49% 40% 45% 41% Your mental well-being 36% 48% Your stress level Your health overall 22% 21% 46% 58% Your body weight Your physical fitness 19% 16% 36% 44% Very Satisfied Somewhat Satisfied Q7. In general, how satisfied are you with each of the following? Base: Total Respondents (n=1,003) 5

6 Motivating Factors for Healthy Lifestyles: An Research Study When we looked at what motivates people to make healthy lifestyle changes, 57 percent cited the desire to prevent serious health problems in the future as most important (see figure 2), with another 37 percent calling it somewhat motivating. A majority also cited the benefits of increased energy, setting a good example for children or grandchildren, being able to be more active, and the ability to be around family members as being very motivating. Overall, the general survey population seemed much more focused on these sorts of health and lifestyle issues than more cosmetic issues, although we ll see a somewhat different response distribution for the weight loss oversample. Figure 2: Future Health Fears Drive Behavior Change To prevent serious health problems in the future To have increased energy in order to do the things I normally do To set an example for my children or grandchildren* To be able to be more active To be around for my family To improve my physical appearance To lose or maintain weight 57% 52% 52% 51% 51% 49% 49% 37% 42% 35% 42% 34% 37% 36% To be physically fit 47% 44% To avoid the health problems faced by my parents or other family members 43% 39% To improve my health metrics (blood pressure, cholesterol, etc.) 42% 43% To feel youthful 40% 42% To help a current health problem 37% 38% Because there is a lot of pressure today from society 17% 31% Because my partner is doing it 16% 33% Very Motivating Somewhat Motivating Q9. Thinking about a healthy lifestyle, to what extent do each of the following factors motivate you to try to live a more healthful lifestyle? Base: Total Respondents (n=1,003), *Base: Those who have children (n=556) 6

7 Motivating Factors for Healthy Lifestyles: An Research Study Overall, the top motivating factors for healthy lifestyle change were fairly similar across the weight loss and smoking cessation groups (see figure 3). Both the general population and the weight loss group were about equally motivated by the desire to improve their physical appearance (86 and 85 percent respectively). There are, however, some significant differences between the groups: 95 percent of the weight loss oversample is motivated by wanting to lose or maintain weight. 82 percent of the smoking cessation group is motivated by the desire to improve a current health problem. The smoking cessation group is less motivated to improve physical appearance (78 percent) or to feel youthful (73 percent) than the general population or the weight loss group. So while there are obviously some concerns that cut across these groups, there are also some population-specific concerns that may play a more important role in behavior change. Figure 3: Motivating Cessation Factor General Population Weight Loss Former Smokers Improve appearance 86% 85% 78% Prevent serious health problems 94% 95% 94% Lose/maintain weight 85% 95% 94% Be physically fit 91% 92% 89% Have increased energy 94% 93% 93% Be able to be more active 93% 93% 92% Be around for my family 85% 83% 84% To feel youthful 82% 80% 73% Help current health problem 75% 78% 82% Set example for children 86% 83% 75% Avoid health problems faced by parents or family 82% 81% 78% Improve health metrics 86% 89% 87% Q9. Thinking about a healthy lifestyle, to what extent do each of the following factors motivate you to try to live a more healthful lifestyle? Base: Total respondents (n=1,003). Base: Those who have children (n=556). Base: All those who quit smoking (n = 330). All those who lost weight (N = 302). 7

8 Motivating Factors for Healthy Lifestyles: An Research Study Behavior Change: Smoking Cessation Strategies The smoking cessation oversample consists of individuals who once smoked 10 or more cigarettes daily and have now been smoke-free for at least one year (see figure 4). Compared to the general survey population, the former smokers are a little older, more male, more frequently unemployed and more likely to have children. In most other status categories, they are similar to the general population, including their self-assessed health status. Figure 4: Who Comprises Smoking Cessation Oversample? Once Smoked 10 or More Cigarettes, Now Smoke-Free for at Least a Year Smoking Cessation Oversample General Population Smoking Cessation Oversample General Population Age Household Income % 35% Less than $50K 39% 51% % 41% $50-$100K 40% 33% % 23% $100K+ 15% 10% Mean Median $55K $45K Gender Education Male 66% 48% Less than college grad 59% 66% Female 34% 52% College grad 32% 27% Employment Status Post-graduate 9% 7% Full time 38% 57% Have Children Part time 12% 13% Yes 73% 55% Not employed 50% 29% No 27% 45% Marital Status Occupation Married/living as married/co-habitating 68% 57% Executive/professional 40% 36% White collar 30% 30% Separated/divorced 14% 13% Blue collar 22% 23% Widowed 7% 4% Health Status Never married 11% 27% Excellent 12% 16% Race Good 63% 67% White 91% 83% Only fair 20% 15% Black 6% 10% Poor 5% 2% Asian 2% 3% Health Care Decision Makers Other 2% 3% Primary/share 96% 91% 8

9 Motivating Factors for Healthy Lifestyles: An Research Study Serious Smokers, Repeat Quitters Prior to quitting, the smoking sample participants were consistent, heavy tobacco consumers (see figures 5-7). Two-thirds had smoked one pack or more per day, and most had tried to quit multiple times previously. The group average is 5.4 unsuccessful attempts. Almost three-quarters have now been smoke-free for more than three years. A potential implication of this is that employers may need to consider a longer-term view of behavior change, and prepare to support employees through an extended process to ultimate success. Figure 5: Smoking Amount 10 per day per day 20 per day 20+ per day 13% 20% 26% 41% S4. How much did you smoke before quitting? Base: All Those Who Quit Smoking (n=330) Figure 6: Successful Quitters Tried Stopping Multiple Times Before 6 or more 1 27% 2 22% 3 18% 4 5% 5 11% 16% Q24. You have succeeded at quitting smoking. How many times did you attempt to stop or quit smoking before you were successful and stopped for good? Base: All those who quit smoking (n=330) Figure 7: Length of Time Smoke-Free 74% 14% 12% S9. How long have you been smoke-free? Base: All those who quit smoking (n=330) 1-2 Years 2-3 Years 3+ Years 9

10 Motivating Factors for Healthy Lifestyles: An Research Study About nine in ten respondents who successfully quit smoking agree that the main reasons they did so center on health (see figure 8): to improve their health (91 percent), to feel better (87 percent), and to live longer (86 percent). About seven in ten count among their primary motivations the desire to see their children grow up and the determination to prove they could quit smoking. The obvious power of these motivating factors may prove a useful insight to employers seeking to increase the persuasiveness of their program communications. Figure 8: Main Motivations: Improve Health, Feel Better, Live Longer I wanted to improve my health I wanted to feel better I wanted to live longer 69% 65% 62% 22% 22% 24% I wanted to see my children grow up 45% 27% I wanted to prove I could do it I wanted to be a role model to my family/childlren I wanted to please my family 30% 25% 44% 25% 26% I didn t want to expose others to secondhand smoke 25% 31% I wanted to help inspire a friend/family member who was also trying 18% 17% 25% I wanted family/friends to admire me 12% 18% I wanted to please my doctor 10% 17% A lot Some Q28. Here is a list of reasons some people have given for quitting smoking. How much do you agree with each statement? Base: All those who quit smoking (n=330). Base: All those who quit smoking and have children (n=242) 10

11 Motivating Factors for Healthy Lifestyles: An Research Study When asked to describe in their own words the secret to successfully quitting smoking this time, just quit or quit cold turkey were the most common responses, cited by nearly one-quarter (23 percent) of respondents (see figure 9). Another 18 percent cited similar descriptions of willpower and strong motivation. 26 percent cited health reasons such as a serious illness or fear of death or illness, and about 16 percent cited temporary substitutes such as the patch, gum and prescriptions. Figure 9: Secrets to Success (Smoking Cessation) Expensive Activity 4% 5% Miscellaneous Alternatives Motivation/Willpower Prayer/Family/Support Just Quit/Cold Turkey Health 12% 16% 18% 21% 23% 26% Q25. What are your secrets to success in quitting smoking this time and not returning to it? Base: All those who quit smoking (n=330) 11

12 Motivating Factors for Healthy Lifestyles: An Research Study The influence cited most frequently by former smokers (78 percent) as a factor in their decision to quit was developing the resolve to finally make the commitment to quit (see figure 10). The second-most important factor was the cost of tobacco (50 percent), followed by a medical diagnosis, event or the advice of a doctor (31 percent). Because these triggers can occur at any time, employers should communicate the availability of support programs and services proactively and continuously, to capture employee awareness when they become open to change. Figure 10: Factors in Decision: Finally Making the Commitment Finally making the commitment 57% 21% Cost increase of tobacco 22% 28% Medical diagnosis or event Advice of a medical professional 20% 19% 11% 19% Became inconvenient to smoke Serious illness of someone close to you Children or grandchildren asked me to quit Elevated health metrics 13% 12% 11% 11% 20% 12% 15% 15% Birth of a child 10% 8% Spouse/partner/family member stopped smoking 9% 11% Marriage 8% 9% Reached major milestone 9% 14% Partner demanded it 8% 11% Death of someone close to you 8% 10% A lot Some Q27. How much did each of the following things factor into your decision to quit smoking? Base: All those who quit smoking (n=330). Base: All those who quit smoking and have children (n=242) 12

13 Motivating Factors for Healthy Lifestyles: An Research Study 17 percent of responding smokers cite a smoke-free workplace policy as being an important factor in their decision to quit (see figure 11). About one in ten cite a workrelated factor in their decision to quit. Employers should carefully consider the impact of smoke-free policies in creating a culture of healthy change. Figure 11: The Role of Work-Related and Other Factors in Decision Smoke-free workplace policy 8% 9% New Year s resolution Birth of a grandchild 8% 8% 6% 6% Friend stopped smoking Intervention of friends Workplace program such as an educational resource Workplace program such as a counseling or coaching program Workplace sponsored incentive program 5% 5% 5% 5% 5% 10% 10% 7% 6% 7% Intervention of co-workers State smoking ban 5% 5% Workplace program such as a competition 4% Co-worker stopped smoking 4% Divorce 3% 6% 7% 6% 8% 7% Other 17% 10% A lot Some Q27. How much did each of the following things factor into your decision to quit smoking? Base: All those who quit smoking (n=330) 13

14 Motivating Factors for Healthy Lifestyles: An Research Study While two-thirds claim to have stopped cold turkey, it appears that other methods contributed as well (see figure 12). Nearly one in five used some sort of smoking cessation aid or product (18 percent), prescription medications (8 percent), or prescription nicotine replacement therapy (4 percent). These results highlight the need for these types of supports in any program intended to enhance cessation success. Figure 12: Methods Used: Cold Turkey and Smoking Cessation Cold turkey Smoking cessation aids (products approved to aid in the cessation of smoking) 18% Help or support of friends or family 12% 67% Prescription medications 8% A family member was quitting too/ at the same time 7% Medical consultation 6% A friend was quitting too/ at the same time 4% Employer-provided smoking cessation in-person counseling 4% Prescription nicotine replacement therapy 4% Stop smoking clinic, class or support group 4% A co-worker was quitting too/ at the same time 3% Acupuncture or hypnosis 3% Books, pamphlets, videos or other material 3% Employer-provided smoking cessation self-help pamphlets/booklets 3% Health information from your employer or health plan website 3% Employer-provided smoking cessation online program 2% Employer-provided smoking cessation phone-based counseling 2% Keep a journal 2% Telephone help line or quit line sponsored by federal or state government 2% Other 13% Q29. Which of these ways or methods did you use to successfully quit smoking? Base: All those who quit smoking (n=330) Health-related items are the most frequently mentioned benefits of smoking cessation. Almost 80 percent of respondents cited a health benefit, ranging from breathing more easily to fewer heart problems. Saving money was cited by 16 percent. In aggregate, lifestyle benefits such as smelling better, looking better and an improved ability to taste food were mentioned by just under half of all respondents. 14

15 Motivating Factors for Healthy Lifestyles: An Research Study Successful Cessation: Insights and Implications Insight: The top factor in quitting smoking, cited by a majority of respondents, was finally making the commitment. Improving health and feeling better are important motivations for the smoking cessation group. Implication: Employers should proactively communicate their smoking cessation programs to capture employees when they finally reach readiness for behavior change. Make sure they are fully aware of your workplace programs. Make enrollment simple and convenient. Communications should leverage the benefit of improved health, feeling better and living longer. While incentives are important to drive participation, it appears they may not be as important in driving outcomes as intrinsic motivation and personal benefits. In addition to health, many smokers cited the importance of family in their decisions to quit. Cost is a key reason to quit smoking, despite the higher income of this sample group relative to the general population. For populations with a large number of parents, messaging that leverages the importance of protecting the health of one s family may be meaningful and motivating. Providing tools that can help smokers better understand the financial benefits of quitting could be useful. Many former smokers attempted to quit many times before succeeding. Workplace programs and smoke-free policies do play a role in respondents decisions to quit. Employers may need to take a longer-term view of behavior change, to ensure that they support employees throughout the continuum of behavior change. Incorporate long-term performance metrics in program assessments. Consider supplementing workplace programs with a smoke-free policy to help create a culture of health. 15

16 Motivating Factors for Healthy Lifestyles: An Research Study Behavior Change: Weight Loss Strategies The weight loss oversample consists of individuals who once weighed 200 or more pounds, lost at least 20 pounds, and have maintained that loss for at least a year. As with the smokers oversample, there are some differences between this group and the general population (see figure 13). It is a little older and contains a higher proportion of males. They have a higher household income, but a similar level of perceived health status. 61 percent of the weight loss group see themselves in good health compared with 67 percent of the general population. Figure 13: Who Comprises Weight Loss Oversample? Once Weighed 200 or More Pounds, Now at Least 20 Pounds Lighter for Over a Year Weight Loss Oversample General Population Weight Loss Oversample General Population Age Household Income % 35% Less than $50K 40% 51% % 41% $50-$100K 40% 33% % 23% $100K+ 15% 10% Mean Median $55K $45K Gender Education Male 68% 48% Less than college grad 48% 66% Female 32% 52% College grad 36% 27% Employment Status Post-graduate 16% 7% Full time 52% 57% Have Children Part time 14% 13% Yes 57% 55% Not employed 34% 29% No 43% 45% Marital Status Occupation Married/living as married/co-habitating 53% 57% Executive/professional 48% 36% White collar 26% 30% Separated/divorced 16% 13% Blue collar 17% 23% Widowed 5% 4% Health Status Never married 26% 27% Excellent 20% 16% Race Good 61% 67% White 89% 83% Only fair 17% 15% Black 7% 10% Poor 2% 2% Asian 1% 3% Health Care Decision Makers Other 2% 3% Primary/share 95% 91% In fact, 40 percent of the weight loss respondents once weighed more than 250 pounds, and more than a third have lost more than 50 pounds. As we consider the factors that enabled these individuals to achieve these reductions, keep in mind that many have lost more than 50 pounds and maintained that reduction for a year or more. Like our smokers, virtually all weight loss respondents have many multiple previous attempts to lose weight an average of 6.4 times before succeeding. Compared to the smoking cessation group, the weight loss sample has maintained its gains for a somewhat shorter time; 45 percent have kept the weight off for 1-2 years, and about one-third for more than three years. 16

17 Motivating Factors for Healthy Lifestyles: An Research Study As in our smoking group, about nine in ten weight loss respondents agree that they acted mainly for health-related reasons (see figure 14): to improve their health (91 percent), to feel better (91 percent), to look better (89 percent), and to live longer (82 percent). Rounding out the top five motivations, eight in ten said they wanted to feel happier (81 percent). Also, like the smokers, a significant segment of the successful weight reducers were motivated by a desire to finally prove they could do it. The prevalence of health and appearance-related motivations offers employers an obvious target for program communications and promotion. Figure 14: Motivations: Be Healthier, Feel & Look Better, Live Longer I wanted to improve my health I wanted to feel better I wanted to look better I wanted to live longer I wanted to feel happier I wanted to feel proud of myself I wanted to see my children grow up* I wanted to prove I could do it I wanted to feel attractive to my spouse/partner 67% 65% 56% 54% 46% 42% 37% 37% 33% 24% 26% 33% 28% 35% 33% 28% 32% 30% I wanted to look younger I wanted to stop taking medication I wanted to be a role model to my family/children I wanted to be able to play recreational sports I wanted family/friends to admire me I experienced an embarrassing situation related to my weight 24% 23% 21% 19% 17% 16% 31% 24% 29% 28% 26% 20% I wanted to be able to walk my pet I wanted to please my family I wanted to help inspire a friend/ family member who was also trying I wanted to please my doctor 14% 13% 12% 11% 16% 27% 23% 27% A lot Some Q35. Here is a list of reasons some people have given for losing weight. How much do you agree with each statement? Base: All those who lost weight (n=302) *Base: All those who lost weight and have children (n=171) 17

18 Motivating Factors for Healthy Lifestyles: An Research Study When asked to describe in their own words the secret to making this weight loss attempt successful, a majority of respondents cited diet-related strategies (57 percent), followed by activity-related mentions (43 percent). Within the activity category, daily exercise tops the list at 29 percent. Smaller portions/portion control was the secondmost mentioned tactic, cited by 27 percent. Obviously, effective employer programs and services must include an educational focus on healthy diet and exercise. Discounts that support affordable access to weight-loss plans, gyms and health clubs may also be beneficial. The most frequently cited factor in respondents decision to lose weight (50 percent say a lot) is finally making the commitment to do it (see figure 15). Interestingly, the second ranking decision driver is the experience of seeing oneself in a photograph or mirror (38 percent), which seems to be a common trigger for commitment these respondents describe. Looking back at their initial attitudes, the weight loss participants tended to perceive themselves as healthier overall than the general population. Visually experiencing the difference between mental self-image and actual appearance seems to be powerfully motivating. The inconvenience of being overweight is the next most frequently mentioned factor in weight loss decisions, cited by one third. Health issues comprise the second tier of factors, along with the fact that clothes no longer fit. Figure 15: Factors in Decision: Control, Realization, Inconvenience Finally making the commitment 50% 26% Saw myself in a mirror/photograph Became inconvenient to be overweight Elevated health metrics 38% 32% 26% 22% 29% 35% Clothes no longer fit Advice of a medical professional Medical diagnosis or event 25% 24% 22% 27% 23% 37% Reached major milestone 13% 17% Serious illness of someone close to you Spouse/partner/family member lost weight Birth of a grandchild Divorce 11% 14% 8% 13% 7% 6% 7% 7% New Year s resolution 7% 13% Birth of a child 6% 8% A lot Some Q34. How much did any of the following factor into your decision to lose weight? Base: All those who lost weight (n=302) 18

19 Motivating Factors for Healthy Lifestyles: An Research Study The Role of the Workplace: Programs and Co-Workers While people seem most influenced by their own health and well-being, the role of the workplace, family members and friends in triggering weight loss behavior change is also apparent. Co-workers who intervened or lost weight themselves are mentioned more than a quarter of the time (27 percent). More than one in ten respondents mention a workplace program as factoring into their decision to lose weight. Obviously, our service populations see these workplace programs as useful resources to support their efforts to change. Successful reducers utilized a wide variety of methods to lose weight, with strong majorities citing strategies in three main categories: Diet The greatest number of respondents (87 percent) report some kind of foodrelated adjustment, from eating less in general to reducing or eliminating certain types of foods. Plans More than seven in ten (71 percent) say they followed some sort of weight loss plan, whether it was one of their own or one provided by their employer. Exercise 69 percent of respondents say that exercise plays a key role in their success, ranging from their own programs to joining a gym. Support methods were cited by almost 37 percent, and medical methods by 21 percent. When asked to rate the most important benefits of weight loss, almost half (48 percent) cited health-related items, from increased energy, stamina, and endurance to better overall health and specific improvements in a variety of biometric markers blood pressure, blood sugar and cholesterol levels, etc. 40 percent reported significant lifestyle improvements, including looking and feeling better, and increased self-confidence. 19

20 Motivating Factors for Healthy Lifestyles: An Research Study Winning at Weight Loss: Insights and Implications Insight: A motivating factor cited by 89 percent of weight loss respondents is the desire to look better. Food and exercise strategies were identified by most successful reducers: 57 percent and 43 percent respectively. Implication: Unlike smoking cessation, weight loss motivation is often related to appearance, with the experience of seeing oneself in a photograph or mirror being a common trigger for behavioral change. This fact can and should be leveraged in communications to encourage that change. Programs should provide consumers with educational opportunities on healthy diet and exercise. Elevated health metrics were a motivating factor for those in the weight loss group more than for those in the smoking cessation sample. People are less satisfied with their physical fitness level than with their mental well-being. The majority of people mentioned diet and activity as secrets to their weight loss. The majority of the general population believes that lifestyle influences health more than genetics. Health fairs, kiosks and other screening programs that help employees monitor their health in a convenient manner may be especially useful to those seeking to lose weight. Physical fitness seems to be an area of significant dissatisfaction (even more so than weight). This may indicate a potentially important role for walking challenges and other programs that promote fitness and exercise. Having a variety of programs available to consumers across a continuum of fitness levels is critical. Programs that offer consumers access to discounts on exercise or foodrelated programs can be helpful especially if integrated into other tools and wellness services. Financial barriers can be a critical impediment to healthy behavior change. While people struggle with behavior change, they do seem to have a sense of personal accountability. 20

21 Motivating Factors for Healthy Lifestyles: An Research Study Examples from Wellness Coaching So how do we incorporate the findings of this survey into our program design and execution, to improve the quality of our outcomes and enhance our impact on employee health and well-being? One of the things our industry is recognizing is the importance of a culture of health in supporting behavior change, and in motivating individuals to achieve and sustain lifestyle improvement. We ve developed a broader view of program and service composition, combining a wide range of resources, activities and communication channels to envelop consumers in a web of positive influence that helps us identify the individuals who are ready to change and proactively engage them when they are most receptive to support. By engaging when consumers are receptive and ready for change, we re better able to help them commit to that change, to act on their commitment, to generate early success, and sustain momentum for the long term. Successful programs optimize engagement by extending pervasive support through a variety of media and channels. Wellness Coaching: An Overview looks at wellness coaching as both a wellness and a prevention program. We accept members regardless of their current state on the health continuum. Whether they need to lose 10 pounds, 50 pounds or maintain their current weight, our coaches provide the support they need to achieve their goals. We take an integrated approach from identification to reporting, with targeted programs for a wide range of risk factors and conditions including: Diabetes lifestyle Exercise Weight management Heart health lifestyle Nutrition Stress Tobacco cessation We believe that everyone should have an opportunity to improve their lifestyle in some way, shape or form, and that wellness coaching can be a great tool for helping individuals engage with experts who can help them get started and move them through the process of achieving their health or lifestyle goals. Our survey results also confirm that diet and exercise are important components of any serious weight loss program. One of the things wellness coaching can do is provide science-based weight loss coaching grounded in the Stages of Change model of behavior change, and delivered through a combination of online and onsite services, including: Multichannel communications and incentives to optimize engagement Dedicated, cross-trained coaches to foster the coaching relationship Motivational interviewing Program intensity and delivery models tailored to individual requirements 21

22 Motivating Factors for Healthy Lifestyles: An Research Study The Importance of Commitment in Smoking Cessation Messaging The respondents in our smoking group were emphatic on the importance of their commitment to change in their eventual success. 70 percent mentioned their determination to prove they could quit tobacco as a strong motivator. The imagery we use in our communications with smokers must address that competitive urge and leverage the emotional power of that challenge. It must be inspirational, playing on the consumer s desire to be healthy and active and to live a long life. QuitPower. Willpower. QuitPower. Willpower. QuitPower. Willpower. Kick the habit. QuitPower can help. QuitPower provides you with: A Wellness Coach who can help keep you motivated Help creating a customized quit plan Stop-smoking aids such as nicotine patches or gum* All available to you at no additional cost as part of your benefit plan. Kicking the habit isn t easy. Maybe you ve tried quitting in the past and lost the fight. You want to succeed and stay healthy for yourself and your family. But, you re not sure how to finally quit for good. That s where QuitPower comes in. When you sign up, you ll have access to a Wellness Coach a trained professional who can motivate and encourage you, and help get you through the rough patches. If you qualify, you also can receive stop-smoking aids such as nicotine patches or gum at no cost. The best part? The program works with your schedule, and you can choose to complete it online, over the phone or by mail. QuitPower s available at no additional cost to you, as part of your benefit plan. Call today you deserve it QUIT-PWR ( ) or visit or visit SM provides information and support as part of your health plan. It is not a substitute for your doctor s care. Your personal health information is kept private in accordance with your plan s privacy policy. For more information, please refer to the telephone number on your health plan ID card. 2008, Inc. OH Kick the habit. QuitPower can help QUIT-PWR ( ) or visit * For those who qualify QUIT-PWR ( ) or visit The Importance of Health and Family in Smoking Cessation Programs Another potentially powerful finding in our survey results is the importance of family concerns as a motivating factor in successful smoking cessation. While the main motivators cited were health-related, family concerns were a close second, with: 72 percent saying they want to see their children grow up 55 percent saying they want to be a role model for their families 51 percent saying they want to please their families 56 percent saying they don t want to expose family members to secondhand smoke 22

23 Motivating Factors for Healthy Lifestyles: An Research Study Women were more likely than men to cite the responsibility for secondhand smoke exposure as a motivation for quitting, but the concern for family welfare knows no gender boundaries. When target population demographics indicate significant family involvement, effective program communications may be created based on these consumer insights. We also heard from smokers that the cost of tobacco is a significant motivator toward smoking cessation. has found that where appropriate, it is extremely effective to help consumers understand the overall costs of smoking. In our programs, a coach welcomes each consumer into the program, discusses the individual s smoking triggers, brainstorms effective coping strategies, then directs the individual to online resources that include a cost of smoking calculator that graphically presents the costs of that individual s tobacco consumption and the savings he or she can realize by quitting. This is just one example of the many ways we leverage consumer insights to improve employee engagement and program impact. 23

24 Motivating Factors for Healthy Lifestyles: An Research Study Final Thoughts There are many different motivating factors that drive people to make behavior change for both weight loss and smoking. Programs that can provide a personalized, holistic approach and that can connect that individual to the tools and resources they specifically need to overcome barriers can be beneficial in supporting behavior change. Readiness to change and the decision to finally make a commitment seem to be the top motivating factors across both weight loss and smoking cessation. Employers should ensure they consistently communicate the availability of these programs to ensure they are top-of-mind when employees are finally ready for behavior change. Employers should view behavior change as a longer-term process. Most who are successful at weight loss or smoking cessation have made numerous prior attempts. Organizations should look at both short- and long-term metrics in their program assessments. While there are commonalities between successful smoking cessation and weight loss, there are clear differences as well. Communications should focus on the unique motivators and benefits to ensure the most relevant and compelling messaging possible. 24

25 Motivating Factors for Healthy Lifestyles: An Research Study Authors Laura Karkula As vice president of product management for, Laura Karkula is responsible for managing the Wellness product portfolio including Wellness Coaching, Onsite Wellness, and Self-Care Publications. Prior to Wellness, Karkula developed, operated and directed several products for including NurseLine, Treatment Decision Support and Health Advocacy. Before joining in January 2002, Karkula held positions in product management and product development for Cargill, and worked as a process and technology consultant with Accenture. Throughout her career, Karkula has held management positions in product, market development, business architecture and information technology. Learn more about how Optum can help your organization improve the impact of employee wellness programs. Contact us at and institute@optumhealth.com Michael W. Rosen, M.D. Dr. Rosen is clinical lead for and leads a team of medical directors who develop and revise clinical content across a wide spectrum of products. Dr. Rosen graduated from the New York University School of Medicine and completed his postgraduate training in Internal Medicine and Hematology at Yale New Haven Hospital and Yale University School of Medicine. Dr. Rosen is boarded in internal medicine and hematology. 1 National Center for Health Statistics. Chartbook on Trends in the Health of Americans Study by the Agency for Health care Research and Quality. lduscol Journal of Epidemiolog ical Reviews 2007 (Reuters) 4 USA Today, Study: Overweight workers cost employers more, April 26, Obesity, July 24, Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses United States, , November Americans for Non-Smokers Rights, Business Costs in Smoke Filled Environments, August Department of Health and Human Services Centers for Disease Control, 2003, Coverage for Tobacco Use Cessation Treatments. About As one of the nation s largest health and wellness companies, makes health care more accessible, affordable and effective for employers, health plans, public sector entities and the 60 million individuals we serve. optimizes the health, well-being and financial security of individuals and organizations through personalized health management solutions. We help people live their lives to the fullest. T institute@optum.com Technology Drive, Eden Prairie, MN All Optum trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners. Because we are continuously improving our products and services, Optum reserves the right to change specifications without prior notice. Optum is an equal opportunity employer. CSWEL0119SCM 2011 Optum, Inc. All Rights Reserved. 25